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First-episode, recurrent, and asymptomatic herpes simplex infections
1Department of Laboratory Medicine, University of Washington, Seattle.
Journal of the American Academy of Dermatology
|January 1, 1988
Summary
Genital herpes simplex virus infections present as either first-episode or recurrent. First-episode infections are more severe, with greater viral shedding, while recurrences are unpredictable. Antiviral treatments may minimally impact herpes epidemiology.
Area of Science:
- Virology
- Infectious Diseases
- Dermatology
Background:
- Genital herpes simplex virus (HSV) infections are broadly categorized into first-episode and recurrent episodes.
- First-episode infections encompass both true primary infections (seronegative individuals) and nonprimary first-episode infections (previously infected individuals).
- Distinguishing between clinical diagnosis and laboratory confirmation of genital herpes is crucial, as cultures are positive more often than clinical diagnosis suggests.
Purpose of the Study:
- To differentiate between first-episode and recurrent genital herpes simplex virus infections.
- To characterize the clinical presentation, viral shedding, and recurrence patterns of genital herpes.
- To assess the potential impact of antiviral treatment on the epidemiology of genital herpes.
Main Methods:
- Classification of genital herpes simplex virus infections into first-episode and recurrent categories.
- Clinical observation and laboratory analysis, including viral isolation from various sites (urethra, cervix).
- Comparison of disease severity, systemic symptoms, and viral shedding between first-episode and recurrent infections.
Main Results:
- First-episode infections exhibit more extensive disease, systemic symptoms, and greater viral shedding compared to recurrent infections.
- Herpes simplex virus can be isolated from the urethra in approximately 30% of males and the cervix in 10-15% of females with recurrent vulvar herpes.
- Primary genital herpes type 2 infections recur in about 95% of cases, while type 1 infections recur in about 50%.
Conclusions:
- Genital herpes simplex virus infections require classification into first-episode and recurrent types for accurate management.
- Recurrence rates differ significantly between HSV-1 and HSV-2, with HSV-2 being much more likely to recur.
- The unpredictable nature of recurrences and the limited impact of antiviral treatments suggest ongoing challenges in managing genital herpes epidemiology.